Do skin prick and conjunctival provocation tests predict symptom severity in seasonal allergic rhinoconjunctivitis?

BACKGROUND: In the investigation of seasonal allergic rhinoconjunctivitis (SAR), quantitative skin and conjunctival allergen challenge tests are used to measure individual allergen sensitivity. These tests are reproducible and relate well to prevalence but their relationship to symptom severity is less well established. OBJECTIVE: We wished to determine if quantitative skin prick tests (QSPT) and conjunctival provocation tests (CPTs) using a single grass pollen allergen extract are reproducible and predict symptom severity in SAR. METHODS: We retrospectively analysed data from 91 participants in a previously published randomized placebo controlled study of low dosage allergen immunotherapy who were randomized to receive placebo treatment. We examined the relationship between pre-seasonal QSPT, CPT and SAR symptoms. RESULTS: We found a high level of reproducibility when repeated measures were compared for both the QSPT (P < 0.001) and the CPT (P < 0.001) and moderate correlation (0.49) between the standard skin prick test (SPT) and the QSPT (P < 0.001). We found weak negative correlation (-0.27) between the QSPT and the CPT (P < 0.001). We found no correlation between seasonal symptom, use of rescue medication or quality of life (QOL) scores and pre-seasonal QSPT or CPT. Conclusion In the assessment of seasonal rhinoconjunctivitis, quantitative skin and conjunctival allergen challenge tests are strongly reproducible, although there is no correlation between these tests and seasonal symptom, use of rescue medication or QOL scores.     

Skin prick-test reactivity to aeroallergens and allergic symptoms in an urban population of central Italy: a longitudinal study

BACKGROUND: Cross-sectional studies report an increasing prevalence of allergic diseases, such as rhinitis and asthma. Not thoroughly known, instead, is the natural history of allergic sensitization and the progress of the allergic disease-related symptoms. AIM: The purpose of this study was to evaluate longitudinally the skin reactivity for the most common aeroallergens and the allergic symptoms in an urban population living in Perugia, a town of central Italy with a low-level of air pollution exposure. METHODS: In the 1998-1999 period 788 subjects were tested for skin reactivity to a panel of aeroallergens and underwent the administration of a questionnaire. These same subjects were part of a cohort of 1200 subjects who participated in a previous epidemiological study performed in 1984-1985 using the same tools. Subjects were aged between 14 and 64 years at the time of the first survey. RESULTS: In the present survey 196 subjects (24.9%) had skin reactivity to at least one aeroallergen, while in the previous survey 143 subjects (18.1%) had skin prick-test reactivity. The increase of the skin reactivity between the two observations was highly significant (P<0.001) and was mainly observed in subjects <40-years old. The greatest increment in skin reactivity was seen to Dermatophagoides pteronyssinus (house dust mite) allergen. Data obtained from questionnaires showed that subjects who declared allergic symptoms increased from 341 (43.3%) to 380 (48.2%). However, the increase was significant (P<0.01) only in subjects who had a positive association between allergic symptoms and prick-test reactivity and was greater for rhino-conjunctivitis than for asthma-related symptoms. CONCLUSIONS: In a cohort of urban population of the centre of Italy, exposed to a low and stable level of air pollution, the sensitization to common aeroallergens increased with time, mostly in people <40-years of age. The greatest increment was found for indoor allergens such as Dermatophagoides pteronysimus. A significant increase in allergic symptoms, mainly related to rhino-conjunctivitis, was observed only in the presence of positive prick test.     

Systemic levels of ceruloplasmin oxidase activity in allergic asthma and allergic rhinitis

Context: The role of ceruloplasmin oxidase activity (COA) involving the interaction of oxidant and antioxidant balance in allergic diseases is still unknown.

Objective: Our study was designed to examine the changes in COAs in severe persistent asthma-allergic rhinitis, new diagnosed allergic asthma-allergic rhinitis and allergic rhinitis patients.

Methods: The study included 20 age- and sex-matched healthy individuals as control (Group I); Group II included 15 newly diagnosed allergic asthma-allergic rhinitis; Group III included 15 patients with severe persistent asthma-allergic rhinitis and in the fourth group there were 20 patients with allergic rhinitis. Group III was divided in two groups, severe persistent asthma-allergic rhinitis who were pre-(III-A) and post-treated (III-B) with omalizumab. Group IV was divided to two groups, pretreatment (IV-A) and posttreatment (IV-B) with specific subcutaneous immunotherapy modalities. All the posttreatment measurements were 12 months after the therapy. All the patients were assessed by the skin prick test, high sensitive C-reactive protein (hs-CRP) and COA.

Results: There were significant differences between Group I and Groups III-A, III-B, IV-A and IV-B; Group II and Groups III-A, III-B, IV-A and IV-B; Group III-A and Groups III-B, IV-A and IV-B; Group III-A and Groups IV-A and IV-B; and Group IV-A and IV-B. Interestingly, there was a correlation between the hs-CRP and COA levels in Group III-A.

Conclusions: Our data suggest that hs-CRP and COA levels might be an indicator of an inflammation and important in revelation of patients with allergy related diseases, especially of asthma patients.     

A multicentre study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China

Background: The prevalence of sensitization in patients with asthma and rhinitis in mainland China remains unclear. Objective: Our aim was to estimate the prevalence of allergy in patients with respiratory allergic diseases such as asthma and/or rhinitis attending respiratory clinics within mainland China. The study also investigated regional and annual differences in the prevalence and pattern of sensitization among the patients in China. Method: A cross‐sectional survey was performed in 6304 patients suffering from asthma and/or rhinitis in 17 cities from 4 regions of China. Patients completed a standardized questionnaire asking for the presence of respiratory and allergic symptoms. They also underwent skin prick tests with 13 common aeroallergens. Results: Among the 6304 patients, 4545 (72.1%) had at least one positive skin prick reaction. The overall prevalence of positive skin prick responses was 59.0% for Dermatophagoides farinae, 57.6% for Dermatophagoides pteronyssinus, 40.7% for Blomia tropicalis, 16.1% for American cockroach, 14.0% for dog, 11.5% for Blatella germanica, 11.3% for Artemisia vulgaris, 10.3% for cat, 6.5% for Ambrosia artemisifolia, 6.3% for mixed mould I, 4.4% for mixed mould IV, 3.5% for mixed grass pollen and 2.2% for mixed tree pollen. Sensitizations to common allergens varied widely between geographical areas and demonstrated unique pattern in patients by stratification with age groups, with asthma and/or rhinitis. Severity of rhinitis and asthma was significantly correlated with skin index of reactivity to Artemisia vulgaris, Ambrosia artemisifolia and to D. pteronyssinus, D. farinae and Blomia tropicalis respectively (P < 0.001). Positive reactivity to the tested allergens and concomitant reactivity to multiple allergens including to house dust mites and Blomia tropicalis was markedly increased in patients with both asthma and rhinitis. Conclusion: House dust mites were the most prevalent allergens in patients with asthma and/or rhinitis in China. There were significant differences in patterns of sensitizations in patients from different geographical areas, age groups as well as asthma and/or rhinitis.     

Incidence and remission of self-reported allergic rhinitis symptoms in adults

BACKGROUND: A few studies have examined the incidence and remission of allergic rhinitis (AR) in the same general population. METHODS: A questionnaire focused on respiratory symptoms and airway diseases was mailed out in 1992 and in 2000 to the same subjects. Of 4933 subjects, in 1992 aged 20-59 years, 4280 (86.8%) answered at both occasions. AR was defined on self-reported AR and a simultaneous report of nasal symptoms provoked by exposure either to tree-, grass-pollen, furred animals or house dust. Multiple logistic regression adjusted for age and gender was used to analyze potential predictors, reported in 1992, for incidence and remission of AR. RESULTS: The prevalence of AR increased from 12.4% in 1992 to 15.0% in 2000. The incidence of AR from 1992 to 2000 was 4.8%, while 23.1% of the cases with AR in 1992 stated no AR symptoms in 2000 indicating remission. The highest incidence was seen in the youngest age group (20-29 years), whereas remission was highest in the oldest age group (50-59 years). Asthma symptoms during the last year (as reported in 1992) predicted increased incidence of AR and less chance for remission, 1.89 (95%CI 1.08-3.31) and 0.52 (0.31-0.87), respectively. Family histories of AR or asthma predicted increased incidence of AR 1.99 (1.42-2.80) and 1.62 (1.10-2.37), respectively, but were not associated with chance for remission, OR = 1.23 (0.81-1.87) and 0.94 (0.60-1.48). CONCLUSION: This study showed that AR became more common between 1992 and 2000, but also indicated remission in about 20% of the cases within the 8-year period, particularly in older ages. Asthma seems to be associated with higher risk for AR as well as less chance for remission, while heredity of asthma (or AR) may only be associated with the risk for the development and not remission of AR.     

Skin prick test can identify eczematous infants at risk of asthma and allergic rhinitis

BACKGROUND: Assessment of allergic sensitization is not routinely performed in infants and young children with eczema. OBJECTIVE: To determine whether infants who have atopic eczema (with sensitization) are at a greater risk of developing asthma and allergic rhinitis (AR) than those with non-atopic eczema (without concurrent sensitization). METHODS: The presence of eczema was prospectively documented until 2 years of age in a birth cohort of 620 infants with a family history of atopic disease. Sensitization status was determined by skin prick tests (SPTs) at 6, 12, and 24 months using six common allergens. Interviews were conducted at 6 and 7 years to determine the presence of asthma and AR. RESULTS: Within the first 2 years of life, 28.7% of the 443 children who could be classified had atopic eczema: 20.5% had non-atopic eczema, 19.0% were asymptomatic but sensitized and 31.8% were asymptomatic and not sensitized. When compared with children with non-atopic eczema in the first 2 years of life, children with atopic eczema had a substantially greater risk of asthma [odds ratio (OR)=3.52, 95% confidence interval=1.88-6.59] and AR (OR=2.91, 1.48-5.71). The increased risk of asthma was even greater if the infant had a large SPT (OR=4.61, 2.34-9.09) indicative of food allergy. There was no strong evidence that children with non-atopic eczema had an increased risk of asthma or AR compared with asymptomatic children. CONCLUSION: In children with eczema within the first 2 years of life, SPT can provide valuable information on the risk of childhood asthma and AR.     

Desloratadine improves quality of life and symptom severity in patients with allergic rhinitis

BACKGROUND: Desloratadine is associated with decreased signs and symptoms and improved nasal airflow in multiple clinical trials in patients with allergic rhinitis (AR). The effect of desloratadine on quality of life (QOL) in AR has not been widely reported to date. We compared the effects of desloratadine and placebo on QOL in seasonal AR using validated, disease-specific measures. METHODS: This was a multicenter, double-blind, randomized, parallel-group study of desloratadine 5 mg or placebo daily for 2 weeks in patients with symptomatic seasonal AR. QOL was assessed at baseline and at day 14 using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). AR signs/symptoms and the global response to therapy were measured at baseline and at day 14; signs/symptoms were also rated AM/PM in patient diaries. Adverse events (AE) were recorded. RESULTS: Overall 234 patients received desloratadine and 249 received placebo. At day 14 desloratadine was associated with a significantly larger improvement from baseline in the mean total RQLQ score vs placebo (P = 0.0003). Desloratadine also led to significant improvements from baseline in all RQLQ sub-domains (P < or = 0.043). At day 14 significant decreases from baseline were noted in the desloratadine group for total nasal (P = 0.0003), total non-nasal (P = 0.001) and total symptoms scores (P = 0.0001). Morning AR symptoms were significantly decreased in the desloratadine group after 1 day of treatment. Desloratadine was well tolerated, with an AE rate similar to placebo. CONCLUSION: Significant reductions in signs and symptoms of AR with desloratadine treatment were accompanied by improved disease-specific QOL measures.     

Allergy screening in asthma and allergic rhinitis

To detect atopy by a screening method employing skin prick testing with a limited number of allergens, the test results of 939 patients with allergic airways diseases were analysed. It was found that an allergen panel consisting of cat, timothy and house dust mite could detect 85% of atopic patients with asthma and/or rhinitis. For subgroups of patients the results were even more favourable. Thus 98% of atopic patients with seasonal allergic rhinitis were detected by an allergen panel consisting of timothy, birch and mugwort. It is concluded that screening methods using only three of four allergens could be used for detecting atopy in patients with airways diseases. The method should be most valuable for in vitro tests used in combination with standardized questionnaires.     

Skin tests, T cell responses and self-reported symptoms in children with allergic rhinitis and asthma due to house dust mite allergy

Background In allergic responses, a distinction is made between an early-phase response, several minutes after allergen exposure, and a late-phase response after several hours. During the late phase, eosinophils and T cells infiltrate the mucosa and play an important role in inflammation. Objective The aim of this study was to examine the relationship between allergen-induced late-phase skin responses and in vitro T cell reactivity. In addition, the relationship between allergen-induced skin or T cell responses and the severity of self-reported symptoms was studied in children with house dust mite allergy. Methods A total of 59 house dust mite-allergic children (6–18 years) were recruited in general practice. These children or their parents rated their nasal and asthma symptoms on diary cards during 1 month. Allergen skin tests were performed and read after 15 min (early phase) and 6 h (late phase). Allergen-specific T cell proliferation was determined, and Th2 cytokine (IL-5 and IL-13) secretion was analysed. Results The size of the late-phase skin response correlated with in vitro T cell proliferation (r_s=0.38, P=0.003) but not with Th2 cytokine secretion (r_s=0.16, P=0.2 for both IL-5 and IL-13). Moreover, the late-phase skin response and T cell proliferation correlated with asthma symptoms (r_s=0.30, P=0.02 for skin response and r_s=0.28, P=0.03 for T cell proliferation) but not with nasal symptoms (r_s=0.19, P=0.15 for skin response and r_s=0.09, P=0.52 for T cell proliferation). The early-phase skin response correlated with the nasal symptom score (r_s=0.34, P=0.01) but not with asthma symptom scores (r_s<0.005, P=0.97). Conclusion In this study, the late-phase skin test response correlated with in vitro T cell proliferation but not with Th2 cytokine secretion. We found weak or no correlations between late-phase skin responses and symptoms of asthma or rhinitis in children with house dust mite allergy. This suggests that late-phase skin responses reflect certain T cell properties but are of limited value for the evaluation of airway symptoms in atopic children.     

Relationship between allergic rhinitis, disturbed cognitive functions and psychological well-being

BACKGROUND: Symptomatic allergic rhinitis reduces quality of life as a result of the symptoms experienced and possibly as a result of impaired psychological well-being and cognitive functioning. Few investigations have measured cognitive functions objectively and it remains uncertain whether allergic rhinitis leads to an objective reduction in cognitive functions. OBJECTIVE: To evaluate the relationship between symptomatic allergic rhinitis, cognitive functions and psychological well-being. Differences between subjective and objective cognitive impairments were evaluated. METHODS: The cognitive functions (working memory, memory retrieval, speed of information processing and flexibility of information processing) and psychological well-being of 26 patients with symptomatic allergic rhinitis and 36 healthy controls matched for intelligence, education, age and sex were compared. The influence of education, intelligence, sex and age was considered. RESULTS: Overall, psychological well-being was significantly impaired in the patient group, as shown by higher scores in feelings of insufficiency, complaints of somatization, sleep disturbances and depressive feelings, whereas cognitive function was not. CONCLUSIONS: Allergic rhinitis was related to significantly impaired psychological well-being and to perceived impaired cognitive functioning. However, no significant objective impairment of cognitive functioning was found. Allergic patients may temporarily put more effort into sustaining performance, resulting in earlier exhaustion, which is not noticed during assessment but which impairs psychological well-being.     

Serum interleukin-17 levels are related to clinical severity in allergic rhinitis

Background:  T helper (Th)-17 cells are a subset of T helper lymphocytes that exert regulatory activities. Recently, it has been reported that serum interleukin (IL)-17 levels are high in the most severe cases of birch allergy studied outside the pollen season.
Objective:  The aim of this study was to investigate a possible relationship between serum IL-17 levels and clinical parameters in patients with allergic rhinitis studied during the pollen season.
Methods:  In all, 56 patients with persistent pollen-induced allergic rhinitis were evaluated during the pollen season. Serum IL-17 levels were evaluated by enzyme-linked immunosorbent assay. Symptoms were assessed by visual analogue scale, drug use was monitored and peripheral eosinophils were counted.
Results:  Serum IL-17 levels were significantly related to clinical symptoms, drug use and peripheral eosinophil counts ( P  = 0.0001 for all).
Conclusion:  This study provides evidence that serum IL-17 level assessment might be considered to classify allergy severity.     

Specific IgE serum concentration is associated with symptom severity in children with seasonal allergic rhinitis

Background: The impact of allergen‐specific and total IgE serum levels before and during the pollen season on symptom severity as well as efficacy of treatment with anti‐IgE requires further delineation. Methods: Birch and grass pollen allergic patients aged 6–17 years with seasonal allergic rhinitis (SAR) were analyzed for the association of IgE serum concentration with symptom severity and rescue medication use (combination: symptom load, SL) during the grass pollen season. Reference group A (n = 53) received placebo, while group B (n = 54) received Omalizumab (anti‐IgE) monotherapy before and during the grass pollen season. Results: Patients on placebo with high baseline specific grass pollen IgE (>50 kU/l) had a significantly higher SL compared with those with low IgE levels (≤50 kU/l): SL 1.28 vs 0.61, P = 0.015. This association was nonexistent in patients treated with anti‐IgE. In contrast, baseline total IgE levels did not correlate with SL in any group. Patients with anti‐IgE treatment and high free total IgE levels (>16.7 ng/ml) had a significantly higher SL compared with those with low free total IgE levels (≤16.7 ng/ml): SL 0.63 vs 0.23, P = 0.031. Conclusions: Baseline specific IgE, but not total IgE, is associated with symptom severity during the pollen season in children with SAR. Likewise, the symptom load in SAR patients with anti‐IgE correlates with free total IgE levels. Although further research in larger populations is needed to confirm our findings, our data suggest that specific IgE can be used as a parameter for patient selection for this kind of treatment.